Atropine Treatment for Myopia

At the Pediatric Ophthalmology Subspecialty Day, Donald Tan, MD, FRCS, FRCOphth, presented an overview of research on atropine treatment for myopia and introduced his latest trial, ATOM3.

ATOM1 and ATOM2. In 1999, Dr. Tan and his team began the 3-year ATOM1 study to assess the use of 1% atropine in children with myopia. This was followed by the 5-year ATOM2 trial comparing the safety and efficacy of 3 lower concentrations of the drug.

“People were really pleased with the safety profile overall,” said Dr. Tan, referring to the ATOM2 trial. There were no ocular complications, cataracts, rise in IOP, or retinal changes, nor was there loss of accommodation or permanent pupil dilation after ceasing treatment.

Analysis of the first 2 ATOM trials showed no significant differences between 1%, 0.5%, 0.1%, and 0.01% atropine doses during the 2-year treatment. However, the children who received higher doses exhibited the largest rebound in myopic progression after ending atropine therapy. Overall, atropine 0.01% eyedrops appear to reduce myopic progression by about 50% with minimal rebound.

Literature overview. Over the years, several other studies have tested atropine treatments for myopia. Dr. Tan reviewed meta-analyses for myopia control that further supported the use of atropine therapy for myopia. The Academy Ophthalmic Technology Assessment of 17 studies reported level I evidence supporting atropine treatment to prevent myopic progression. The data suggested that lower doses could help minimize myopic rebounds.

Nevertheless, “I think we need to be a little bit careful interpreting these studies,” advised Dr. Tan. The atropine formulations, he suggested, can vary between studies.

On the horizon. Circling back to the session’s theme of myopia prevention, Dr. Tan explained that this condition is a serious problem among schoolchildren in Singapore. He estimates nearly 90% of Singapore schoolchildren will develop myopia. He said they can now safely predict young patients as “premyopes.”

His current study, the ATOM3 trial, therefore focuses on tackling this problem. The study includes children 5 to 9 years old with a refractive error between +1.0 and –0.49 and at least 1 myopic parent. In this study, initiated in the summer of 2017, participants are randomized to receive 0.01% atropine or placebo drops for 2.5 years, with follow-up after 1 year without atropine. Dr. Tan hopes that this treatment will help prevent or delay the onset of myopia in premyopic children.—Kanaga Rajan